Patient adherence: The greatest risk to any home-centered care program

The Centers for Medicare and Medicaid Services (CMS) recently announced the continued success of its Independence at Home demonstration, which achieved more than $10 million in Medicare savings in its second year.

That's an average of $1,010 per beneficiary for participants in the pilot program that aims to expand in-home primary care for individuals with chronic disease.

The success of the Independence at Home Demonstration is no surprise for home-centered care advocates, who recognize the potential of homecare programs to deliver high quality outcomes and reduced costs.

Consider some of the potential benefits of in-home care:

• Reducing/preventing readmissions, or admissions. Emergency department visits and hospital inpatient stays are the most expensive ways to deliver care, and the most uncomfortable and distressing for consumers. By delivering routine and preventative care at home, home-centered programs seek to keep individuals healthy, and to identify early signs and symptoms that may signal the advent of a more acute episode or disease exacerbation.

• Improving workflow efficiency/productivity. Along with the aging population, providers are also subject to the same demographic trends, and a shortage of care professionals to treat the grey tsunami means efficiency and productivity are critical. In-home monitoring can help identify the patients who need attention and the most efficient way to deliver needed services, while keeping an eye on lower-intensity patients electronically, preventing wasted resources.

• Improving participant satisfaction. Studies repeatedly show that patients who are treated at home, in the community, with access to friends and family, report more satisfaction with their care and have better outcomes than those who end up in inpatient or long term care facilities. Home-centered care programs help keep individuals with chronic disease stable and at home longer, thereby increasing patient satisfaction.

• Lower costs. Home-centered care, even when considering the cost of the technology required, is typically less expensive than other options.

Recognition of value brings inspires the introduction of challenging new models

Despite the benefits of in-home care, home-centered care organizations are facing new challenges as the industry transitions to new value-based payment models. Like other post-acute care providers, home care providers are realizing the impact of programs such as the Bundled Payment for Care Improvement initiative, which sets a single spending target for all applicable health services provided during a clinical episode of care over a specified period of time.

For example, a bundle payment might cover a 90-day episode of care for total joint replacement, including the hospital stay, physician services, outpatient care, a skilled nursing facility (SNF), home care, and readmission. All the providers are incentivized to help patients recover quickly and avoid being readmitted to the hospital, where care costs are highest. For post-acute providers, who also rely heavily on referrals from other providers, quality patient outcomes are essential for the long term success of their business.

Maintaining efficiencies while under scrutiny

Home-centered care organizations are also experiencing heavy scrutiny by Medicare as the federal government works to address concerns of fraud, waste and abuse. A June, 2016 report from by the HHS' Office of Inspector General found that more than 500 home healthcare agencies – or about 5% of the total – and 4,500 doctors share characteristics that point to home healthcare fraud. In 2015, Medicare paid these providers for more than 100,000 home health episodes, totaling $273 million.

The federal government is now stepping up its enforcement efforts and working to identify additional providers who may have made or accepted payments for patient referrals, falsely certified patients as homebound, or billed for medically unnecessary services or for services that were not rendered. For home-centered care organizations that are dedicated to proper billing and ethical patient care, the increased demand for documentation and the threat of audits represent an additional administrative burden that most agencies are ill-equipped to address. In order to maintain operational and clinical efficiencies in the face of this increased oversight, home-centered care organizations need digital technologies that enhance the care process and improve their ability to compete in the market.

Patient adherence in healthcare: the right technology is key

Across the healthcare spectrum, patient adherence remains the elusive holy grail with a massive potential to deliver tremendous value. Whether in the individual's home, within the four walls of a hospital, at a managed care facility or at the local pharmacy, patient adherence to prescribed care plans is essential for achieving quality outcomes.

Most provider organizations struggle to successfully engage patients in healthy behaviors. At the same time, healthcare reformers remain convinced – and rightly so – that consumer engagement is one of the most critical factors for the long-term viability of value-based care models, which reward providers for quality outcomes. Fortunately, the healthcare sector is beginning to embrace new technologies that leverage machine-learning, predictive analytics, and behavior assessment to drive patient adherence and sustain consumer engagement.

Remote monitoring tools can automate routine tasks, such as capturing vital signs. The addition of analytics provides valuable insights into the health of an individual based on collected data and contextual information. Over time, as additional data is captured and available for analysis, these insights become more precise. In the world of value-based medicine, this type of data is critical for predicting the likelihood of adverse events so that caregivers have adequate time to enact proactive measures that enhance outcomes.

Such solutions are even more powerful with the addition of digital health tools and apps that assess the unique personalities of each individual to accurately identify potentially non-adherent patients. The incorporation of behavioral-based tools can automatically flag individuals that are high risk for non-compliance and allow caregivers to tailor their communications, treatments and medication plans. By leveraging technology that recognizes the uniqueness of each patient, care and engagement can be customized to optimize patient adherence and health outcomes.

Caution: Choose Wisely

CMS is to be lauded for innovative programs such as its Independence at Home Demonstration and Bundled Care Improvement program, which seek to improve care and reign in healthcare costs. More organizations are now recognizing the need for updated technology solutions to enhance the delivery of care and reduce costs; at the same time, providers are realizing that not all technology suites are created equal.

Case in point: despite the proliferation of wearable health devices and remote monitoring systems in recent years, the preventative impact related to adverse events and readmissions among individuals with chronic disease across the sum total of this technology has clearly been underwhelming, and often-times confusing. Consumers, payers and providers realize they must choose their technology wisely to ensure the delivery of care that is both beneficial and cost-effective.

Across the post-acute care segment in general, financial and clinical success requires technology solutions that are proven to monitor and encourage patient engagement and adherence. In the home-centered care arena specifically, solutions must promote the prescriptive utilization of collected data and the empowered personalized engagement of participants. When home care organizations supplement their care programs with remote monitoring, machine-learning and predictive analytics, they become an invaluable partner amongst providers working to achieve optimal outcomes under new value-based care models.

Mark Heinemeyer serves as Chief Collaboration Officer for Wanda, Inc. and has a reputation for creatively developing fresh solutions to real problems by leveraging emerging technologies and integrating seemingly disparate, yet complimentary, organizations. Mark recently held senior executive positions with NantHealth and Global Care Quest. In addition to CEO and SVP positions at Fiserv, Cigna, HCA, and CorVel, he has led growth acceleration for several early stage healthcare technology companies.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​